Provider Demographics
NPI:1346954989
Name:CASTLEBERRY, DUSTIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:CASTLEBERRY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20873 EVA ST STE C
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-1975
Mailing Address - Country:US
Mailing Address - Phone:936-597-5323
Mailing Address - Fax:936-597-8914
Practice Address - Street 1:20873 EVA ST STE C
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-1975
Practice Address - Country:US
Practice Address - Phone:936-597-5323
Practice Address - Fax:936-597-8914
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3130087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3130087OtherSTATE LICENSE